State Behavioral Risk Factor Surveillance Research Articles

Treatment and Awareness of Type 2 Diabetes in Beijing, China, Compared to New York

The purpose of this study was to determine awareness and treatment of type 2 diabetes among Beijingers. Surveys generated in Mandarin and English were used to poll 75 Beijingers with type 2 diabetes, 29 Beijingers without diabetes, and 23 New Yorkers without diabetes. Beijing data were compared with diabetes statistics on exercise and blood glucose testing frequency from the 2002 New York City Department of Health and Mental Hygiene Community Health Survey and the 2003, 2004, and 2005 New York State Behavioral Risk Factor Surveillance System. The surveyed Beijingers with diabetes used primarily only Western pills to treat their type 2 diabetes, and a smaller percentage used traditional Chinese medicine. Most of the surveyed Beijingers with diabetes wrote that they exercised regularly. Most exercised at least 7 times per week. About half of the surveyed Beijingers with diabetes had no food restrictions. Virtually all of the surveyed Beijingers with diabetes tested their blood glucose, but approximately half of these individuals tested less than 1 time per week. Beijingers with diabetes were less aware than New York respondents who did not have diabetes of what diabetes is and the consequences of poor diabetes treatment. Beijingers who did not have diabetes were less aware than New Yorkers who did not have diabetes of what diabetesis, the symptoms, the causes, the treatments, and the consequences of poor diabetes treatment. The results indicate that compared to New Yorkers with diabetes, Beijingers with diabetes tended to exercise much more frequently but tested their blood glucose less frequently. With the projected increase of type 2 diabetes in Beijing, more efforts need to be made to increase the frequency of blood glucose testing and basic diabetes awareness.

Underreporting of Work-Related Injury or Illness to Workers??? Compensation: Individual and Industry Factors

We quantified the underreporting of work-related injury or illness to workers' compensation (WC). Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52% filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing varies considerably across industry and occupation groups holding all other measured factors constant. Individual and industry/occupation factors are related to underreporting of work-related injury or illness to the WC system.

Evaluating the effectiveness of health promotion policy: changes in the law on drinking and driving in California

The purpose of the study was to determine the utility of general population health surveillance data for evaluating broad policy changes that relate to health promotion. Data were drawn from the United States (US) Behavioral Risk Factor Surveillance System (BRFSS) for one US state, California. Because these data are collected frequently and continually, a quasi-experimental approach to the evaluation was possible using a type of interrupted time series analysis or longitudinal impact analysis. A statistically significant decrease in the number of declared episodes of drinking and driving was found after enactment of new state policy. These findings were compared and found consistent with another study in California that examined the effect of changes in the law on alcohol-related traffic accidents. Our findings suggest that data from a behavioral surveillance system, in this case the BRFSS, are useful to evaluate the effect of a health promotion intervention. Further, the study demonstrates the utility of comparing different data sources when assessing a population-wide change in health promotion policy.

Inclusion of people with disabilities in telephone health surveillance surveys.

Telephone survey data are widely used to describe population health, but some fear that people with disabilities cannot participate. We tested the hypothesis that a telephone survey would underrepresent adults with disabilities, and that the adults with disabilities who responded would report lower prevalences of sensory, mental, self-care, and multiple limitations than those observed in people with disabilities in the general population. We compared characteristics of adults with disabilities identified by the 2001 Washington State Behavioral Risk Factor Surveillance Survey (BRFSS) to Washington adults with disabilities in the Census 2000 Supplementary Survey (C2SS), to 2 BRFSS Disability Supplements, and to the Washington State Population Survey. All except the C2SS are telephone surveys. Contrary to expectations, post hoc analyses of all telephone surveys found significantly higher prevalence of disability in the Washington adult population than did the C2SS. The hypothesis of more sensory, mental, and self-care limitation in telephone disability samples was supported in only 2 of 11 instances in which a disability sample was asked about 1 of these limitations. Findings were not explained by differences in disability definition or type of informant. These results suggest that population telephone surveys do not underrepresent adults with disabilities. The counterintuitive finding of their higher survey participation raises further questions.

Body mass index and the risk of asthma in adults

Asthma and obesity are both chronic conditions and their prevalences have risen in affluent societies. A positive association between asthma and being overweight or obese has been reported in children and women, but associations in men are less clearly described. The objective of this study was to explore the association between body mass index (BMI) and asthma in men and women of diverse ethnic and socioeconomic background living in New York State, USA. In this study, we analyzed cross-sectional data on 5524 subjects aged 18 years and older who were interviewed by telephone in the 1996 and 1997 New York State Behavioral Risk Factor Surveillance System. Asthma (doctor-diagnosed), and weight and height were self-reported. BMI (kg/m 2) was used as a measure of adiposity. Weighted logistic regression analysis, with stratification by gender and age, was used to examine the relationship between asthma prevalence and BMI, adjusting for race/ethnicity, education, health insurance, time since last physical examination, physical activity and smoking status. The results showed that the prevalence of asthma was 4.6% (CI: 3.6–5.5%) among men and 8.1% (CI: 7.1–9.1%) among women. In women, the prevalence of asthma was significantly increased in those with a BMI 25 kg/m 2 or higher (BMI 25–27.5: OR=1.76, 95% CI:1.06–2.94; BMI 27.5–29.9: OR=2.45, 95% CI: 1.41–4.25; BMI⩾30: OR=2.67, 95% CI: 1.66–4.29) when compared to the reference category (BMI: 22–24.9 kg/m 2). In men, the prevalence of asthma was increased in the lowest weight category, BMI<22 kg/m 2 (OR=3.05, 95% CI:1.37–6.78) and in the highest category, BMI⩾30 kg/m 2 (OR=2.92, 95% CI:1.39–6.14). This U-shaped association persisted when restricting the analysis to men who had never smoked and was more pronounced for those between 18 and 49 years of age. In conclusion, this cross-sectional study showed that men and women differ significantly in the association between BMI and asthma prevalence only with respect to the lowest weight category. While women had a monotonic association, men showed a U-shaped relationship, indicating that both extremes of weight are associated with a higher prevalence of asthma.

Childhood family violence history and women’s risk for intimate partner violence and poor health

Background There is growing evidence for associations between generations in family violence and between family violence in both childhood and adulthood and women’s health. Most studies focus on a subset of family violence (child abuse, witnessing intimate partner violence [IPV] as a child, and/or adult IPV), and few examine possible differences associated with the nature of abusive experiences, such as physical versus sexual abuse. Methods A population-based telephone survey, the 1999 and 2001 Washington State Behavioral Risk Factor Surveillance System, asked a representative sample of 3527 English-speaking, non-institutionalized adult women whether they had been physically or sexually assaulted or witnessed interparental violence in childhood, and whether they had experienced physical assault or emotional abuse from an intimate partner in the past year. The survey also asked about current general health and mental distress in the past month. Results The risks associated with childhood family violence experiences varied depending on the nature of those experiences. Women reporting childhood physical abuse or witnessing interparental violence were at a four- to six-fold increase in risk of physical IPV, and women reporting any of the experiences measured were at three- to four-fold increase in risk of partner emotional abuse. In contrast, women reporting childhood sexual abuse only were not at increased risk of physical IPV. Women reporting childhood physical abuse were at increased risk of poor physical health, and women reporting any type of childhood family violence were at increased risk of frequent mental distress. Approximately one third of women reporting poor general health and half of women reporting frequent mental distress also reported at least one of the childhood experiences measured. Conclusions These findings underscore the role of childhood experiences of abuse and of witnessing family violence in women’s current risk for IPV, poor physical health, and frequent mental distress.

Prostate Cancer Screening Trends of New York State Men at Least 50 Years of Age, 1994 to 1997

Background. Despite the lack of consensus on prostate cancer screening recommendations, men are being screened at high rates in some states. Our objective was to examine the trends in prostate cancer screening awareness and practices from 1994 through 1997 and the relationship among screening practices and demographic characteristics, perceived risk, and family history of prostate cancer.Methods. Data from the New York State Behavioral Risk Factor Surveillance System surveys and questionnaire modules on prostate cancer screening were used for this study, which excluded men younger than 50 years of age and men with a history of prostate cancer. The questionnaires were administered by random-digit-dialed monthly telephone surveys of the civilian, noninstitutionalized adult population in New York State.Results. A total of 295, 336, 273, and 448 men, the vast majority of whom were white, met the study criteria for 1994, 1995, 1996, and 1997, respectively. Each year the percentage of men who reported having heard of the prostate specific antigen (PSA) test increased (test for trend, P < 0.001). Among those who had heard of the PSA test, the percentage who reported having had a PSA test increased steadily from 1994 to 1997. About 30% of the men in each year's study did not have an impression of their risk of getting prostate cancer.Conclusions. Given the increasing rate at which men are reporting being screened for prostate cancer and given their reported perceived risk levels, perhaps more needs to be done to educate men about screening implications and personal risk for prostate cancer.

Self-reported childhood sexual and physical abuse and adult HIV-risk behaviors and heavy drinking

Context: Although studies of clinical samples have identified links between childhood abuse, especially sexual abuse, and adult health-risk behaviors, the generalizability of these findings to the population and the relative importance of different types of abuse in men and women are not known. Objective: To estimate the risk of self-reported adult HIV-risk behaviors and heavy drinking that is associated with self-reported childhood histories of physical and/or sexual abuse for men and women in a general-population sample, after controlling for age and education. A second objective is to determine whether, among women, early and chronic sexual abuse is associated with heightened risk compared to later or less extensive abuse. Design: A population-based telephone survey, the 1997 Washington State Behavioral Risk Factor Surveillance System (BRFSS), asked a representative sample of adults whether they had ever been physically or sexually abused in childhood, and if so, the age at first occurrence and number of occurrences. The survey also asked about levels of alcohol use and, for those under 50 years, about HIV-risk behaviors. Participants: Three thousand four hundred seventy-three English-speaking non-institutionalized civilian adults in Washington State. Main Outcome Measures: Self-reported HIV-risk behaviors in the past year and heavy drinking in the past month. Results: We identified associations between reported abuse history and each health-risk behavior that we examined. For women, early and chronic sexual abuse (occurring without nonsexual physical abuse) was associated with more than a 7-fold increase in HIV-risk behaviors (odds ratio [OR], 7.4; 95% confidence intervals [CI] 2.4 to 23.5); and any sexual abuse, combined with physical abuse, was associated with a 5-fold increase in these risk behaviors (OR, 5.0; 95% CI, 2.2 to 11.5). For women, only combined sexual and physical abuse was associated with heavy drinking (OR, 6.2; 95% CI, 2.2 to 16.9). Physical abuse alone was not associated with either health-risk behavior for women. For men, any sexual abuse was associated with an 8-fold increase in HIV-risk behaviors (OR, 7.9; 95% CI, 1.8 to 35.1). Physical abuse alone was associated with a 3-fold increase in risk of HIV-risk behaviors (OR, 3.2; 95% CI, 1.3 to 7.9) and a similar increase in risk of heavy drinking (OR, 3.2; 95% CI, 1.8 to 5.5). Although only 29% of the women and 19% of the men who were asked about HIV-risk behaviors reported any history of childhood abuse, these accounted for 51% and 50% of those reporting HIV-risk behaviors, respectively. For heavy drinking the corresponding figures were 25% of the women and 23% of the men reporting any abuse, who accounted for 45% and 33% of those reporting heavy drinking, respectively. Conclusions: Efforts to prevent or remediate adult health-risk behaviors should consider the possibility of a history of childhood abuse, as one third to one half of those reporting HIV-risk behaviors or heavy drinking in a general-population survey also reported childhood abuse.

Smoking Prevalence of Pregnant Women Compared to Women in the General Population of Washington State

We used two readily available sources of information to identify subgroups of pregnant Washington State women with high smoking rates. We compared smoking rates in pregnant women and women in general using information from the Washington State birth certificate collection system and the Washington State Behavioral Risk Factor Surveillance System. Smoking rates are substantially higher in young mothers 18-24 years of age than in comparable age cohorts in the general population of women in the state. In contrast, mothers 25 years of age and older smoke at lower rates than their age cohort in the general population. For multiparous women of all ages, smoking prevalence is related to age at first birth. Married women, whether pregnant or not, smoked less than unmarried women.